Individual
IKAEHOTA AIGBIVBALU NYOWHEOMA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
O.D
Contact information
Practice address
300 MEMORIAL CITY WAY, HOUSTON, TX 77024-2599
(713) 647-0864
(713) 772-4004
Mailing address
PO BOX 300997, HOUSTON, TX 77230-0997
(713) 647-0864
(713) 647-0867
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
05059
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
019163701
—
TX
01
—
THJXB3DJ
OPTICARE
TX
Enumeration date
07/18/2006
Last updated
06/21/2011
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